Early Surgical Outcomes of En Bloc Resection Requiring Vertebrectomy for Malignancy Invading the Thoracic Spine
| Autor: | Katherine Armstrong, Mauricio Perez Martinez, Raphael Bueno, Yolonda L. Colson, Michael T. Jaklitsch, Carlos E. Bravo Iñiguez, Jon O. Wee, Christopher M. Bono, Marco Ferrone, John H. Chi, Gita N. Mody, Abraham Lebenthal, Scott J. Swanson |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Lung Neoplasms Time Factors Adolescent medicine.medical_treatment 030204 cardiovascular system & hematology Malignancy Thoracic Vertebrae Young Adult 03 medical and health sciences Pneumonectomy 0302 clinical medicine medicine Humans Neoplasm Invasiveness Orthopedic Procedures Thoracotomy Stage (cooking) Aged Spinal Neoplasms business.industry Middle Aged medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Thoracic vertebrae Vertebrectomy Current Procedural Terminology Female Radiology Sarcoma Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 101:231-237 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2015.05.113 |
| Popis: | Background En bloc vertebral resection of locally invasive T4 lung cancers led to the development of a surgical sequence for resection; posterior stabilization, reposition, thoracotomy, lobectomy, vertebrectomy, and anterior spine stabilization in 1 procedure. This technique expanded indications for vertebrectomy to selected patients with sarcoma and metastatic disease. We review our experience to identify areas for clinical improvement. Methods Operative case logs were cross-checked with billing data from 2003 to 2014 with Current Procedural Terminology (CPT, American Medical Association) codes for vertebrectomy. Thirty-two cases involving en bloc resection of malignancy invading at least 1 thoracic vertebra were selected. Outcomes data were analyzed using summary statistics. Results Series includes 14 men and 18 women, median age 50 years. Twenty-five patients (78%) received preoperative chemoradiation. Nineteen total and 13 partial vertebrectomy were performed. Average number of vertebrae resected was 1.6 (range, 1 to 4). Median operative length was 8.5 hours (range, 2.8 to 14.5), mean blood loss 923 mL (SD ± 477 mL), and median length of stay 8 days (range, 3 to 56). Major morbidity followed 56% of cases. Thirty-day mortality was 3%. Overall median survival was 43.6 months, 1-year survival was 73.6%, and 5-year survival was 40.3%. Conclusions En bloc vertebrectomy for malignant disease is feasible. Our 1 stage and 2 team approach allows completion of the operation within a standard day, but is associated with long operative time. Complication rates may improve with decreased operative times. Review of available data warrants future prospective studies. |
| Databáze: | OpenAIRE |
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